Symptoms of Onychomycosis

• In general, onychomycosis does not cause any symptoms. People with onychomycosis usually go to the doctor for cosmetic reasons, not because of physical pain or problems related to onychomycosis.



• As the disease progresses, onychomycosis may interfere with standing, walking, and exercising.



• Paresthesia (a sensation of pricking, tingling, or creeping on the skin having no objective cause and usually associated with injury or irritation of a nerve), pain, discomfort, and loss of agility (dexterity) may occur. Loss of self-esteem and social problems can also develop.

Symptoms of onychomycosis based on subtype

Onychomycosis is divided into subtypes that can be identified based on symptoms.

• In distal lateral subungual onychomycosis (DLSO), the nail plate is thick with a cloudy appearance (opaque), the nail bed underneath the nail thickens and hardens (nail bed hyperkeratosis), and the nail separates from the bed underneath (onycholysis). The nail can be discolored and appear in a range from white to brown. The edge of the nail becomes severely eroded.



• In endonyx onychomycosis (EO), the nail plate has a milky white discoloration, but unlike DLSO, the nail does not separate from the bed (no onycholysis). The area under the nail (subungual area) does not thicken or harden (no hyperkeratosis).



• White superficial onychomycosis (WSO) is usually confined to the toenails. Small white speckled or powdery-looking patches appear on the surface of the nail plate. The nail becomes rough and crumbles easily.



• In proximal subungual onychomycosis (PSO), an area of white spotting, streaking, or discoloration (leukonychia) develops near the nail fold and may extend to deeper layers of the nail. The nail plate becomes white near the cuticle and remains normal at the end.



• Candidal infection can occur in the toenails and the fingernails. The nail fold becomes inflamed (erythematous), or the nail plate separates from its bed (onycholysis). The nail bed thickens and hardens (nail bed hyperkeratosis), and inflammation of the nail fold is observed in chronic mucocutaneous disease (disease of mucous membrane and regular skin). The affected fingers or toes start to look rounded on the ends, like drumsticks, and, sometimes, the entire thickness of the nail becomes infected.



• In total dystrophic onychomycosis, the nail is thickened, opaque, and yellow-brown. The entire nail plate and matrix are affected.